Amend HB 1366 (second reading engrossment) as follows:                       
	(1)  Add the following appropriately numbered section:                         
	SECTION      .  Subchapter H, Chapter 301, Occupations Code, is 
amended by adding Section 301.354 to read as follows:
	Sec. 301.354. NURSE FIRST ASSISTANTS; ASSISTING AT SURGERY BY 
OTHER NURSES.  (a)  In this section, "nurse first assistant" means a 
registered nurse who:
		(1)  has completed a nurse first assistant educational 
program approved or recognized by an organization recognized by the 
board; and
		(2)  is either:                                                        
			(A)  certified in perioperative nursing by an 
organization recognized by the board; or
			(B)  recognized by the board as an advanced 
practice nurse and qualified by education, training, or experience 
to perform the tasks involved in perioperative nursing.
	(b)  Unless the person is a nurse first assistant, the person 
may not use:
		(1)  the title "nurse first assistant" or "registered 
nurse first assistant";
		(2)  the abbreviation "R.N.F.A."; or                                   
		(3)  any other title or abbreviation that implies to the 
public that the person is qualified as a nurse first assistant under 
this section.
	(c)  A health maintenance organization or an insurer, 
including an insurer offering a preferred provider benefit plan, 
may not, by contract or any other method, require a physician to use 
the services of a nurse first assistant.
	(d)  A nurse who is not a nurse first assistant may assist a 
physician, podiatrist, or dentist in the performance of surgery if 
the nurse:
		(1)  assists under the direct personal supervision and 
in the physical presence of the physician, podiatrist, or dentist;
		(2)  is in the same sterile field as the physician, 
podiatrist, or dentist;
		(3)  is employed by;                                                   
			(A)  the physician, podiatrist, or dentist;                           
			(B)  a group to which the physician, podiatrist, 
or dentist belongs; or
			(C)  a hospital licensed or owned by the state; and                   
		(4)  is qualified by education, training, or experience 
to perform the tasks assigned to the nurse.
	(e)  A patient or third-party insurer may not be billed 
separately for the services performed by a nurse described by 
Subsection (d).
	(f)  A registered nurse must perform circulating duties in 
the operating room.  In accordance with approved medical staff 
policies and procedures, a vocational nurse or surgical 
technologist may assist in circulating duties under the direct 
supervision of the registered nurse.
	(2)  Strike Section 6 of the bill (page 6, line 9) and 
substitute the following appropriately numbered section:
	SECTION      .  Sections 301.1525, 301.1526, 301.1527, and 
304.010, Occupations Code, are repealed.
	(3)  Renumber the sections of the bill accordingly.